The new Blue Cross 2021 Quality Reward Booklet is now available. This booklet outlines the HEDIS quality measures that are included for the Blue Cross 2021 quality programs. The programs outlined in this document are the Primary Care Value Based Reimbursement (VBR) and the Performance Recognition Program (PRP).  In the coming months we will be compiling additional payor details into our Annual Incentive Grid which will detail all of the changes for the year in regard to Network quality programs. Please look for additional details in the first quarter of 2021. 

Summary of BCBM changes for 2021:

  • BCBSM PPO 
    • Added 
      • Well-Child Visits – 0 to 30 Months*
      • Childhood and Adolescent Well Care Visits*
        • *These new measures the specifications for 2021 to be released 
    • Removed
      • Diabetes Care: Monitoring for Nephropathy
      • Well-Care Visits – Adolescence 12 to 21 Years
      • Well-Child Visits – 3 to 6 Years
      • Well-Child Visits – 0 to 15 Months
  • BCN – Performance Recognition Program
    • Added
      • Childhood and Adolescent Well Care Visits
        • Payout goal: Flat Fee  
        • $25 reward  
      • Well-Child Visits – 0 to 30 Months
        • Payout goal: Flat Fee  
        • $100 reward  
      • Pediatric Weight Assessment and Counseling -Nutrition Counseling & Physical Activity Counseling
        • Payout goal: 84%  
        • $30 reward (Combo completed  
    • Removed 
      • Well-Child Visits – 0 to 15 Months
      • Well-Child Visits – 3 to 6 Years
      • Well-Care Visits – Adolescence 12 to 21 Years
      • Diabetes Care: Monitoring for Nephropathy
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